Wednesday I had my monthly lab visit, and inter alia, we discussed my current prescription for peritoneal dialysis. I mentioned that lately, I have been using only 1.5 % solutions across the board, with BP while low OK, and weight hanging in there. She responded that as much as possible we should be using the lowest strength solutions that maintain an acceptable BP and weight. She went on to state that too many of her patients (PD) intake too much fluid, and just resort to using stronger dialysis solutions to pull it off. This in turn damages the lining of the stomach (peritoneum) AND ONCE DAMAGED, DOES NOT HEAL ITSELF.
I had not taken this on board to the extent that I should have. Please take this on board if you are on PD. Walk a straight line. As much as possible, keep fluids to an acceptable level, and DO NOT use stronger dialysis fluid to cover for your weakness and then complain when you have to go on hemo.
I saw out of the corner of my eye in scanning the news Tuesday that Abbott had been granted FDC approval for a CGM that does not require a prescription named Lingo. This makes lots of business sense since they already dominate the prescription CGM market for diabetics’ use of their Libre 3 System. Why not extend their reach into the much larger health-oriented market? BTW, Lingo is currently only available in the UK market. See this link.
From a larger perspective, Abbott and other such companies are going after much larger markets with biowearables. See the video below made in conjunction with CES 2023 for examples.
Elizabeth Cohen wrote an article titled “Bandages of the Future Will Talk to Your Doctor” in the 6/3/24 issue of WSJ, p. A11. This application of technology to bandages is just starting to get off the ground. Basically you have a “normal” bandage with a pocket in it in which some kind of micro device is housed that senses what is going on with the wound underneath the bandages and can take steps to treat it or signal the user of others of the status. The smart bandage is often connected to a smartphone via an app such as my Libre 3 for glucose readings,
Two immediate applications of this evolving technology come to mind: PD patients such as myself and military use.
Smart bandages for PD catheter exit sites could offer improved wound healing, infection prevention, and remote monitoring compared to traditional dressings. This includes:
Sensors to track wound healing progress (e.g., fluid levels,
Bacterial load) Automated dressing changes or alerts for intervention
Wireless data transmission to healthcare providers
Antimicrobial coatings or drug delivery capabilities
Here is how the concept of smart bandages could be applied to military use:
Smart Bandages for the Battlefield
One area where smart bandages could have a significant impact is in military medical care on the battlefield. The unique challenges of treating injuries in combat environments make smart bandage technology particularly useful.
Real-Time Monitoring: Smart bandages equipped with sensors could continuously monitor a soldier’s vital signs, tracking metrics like heart rate, blood pressure, oxygen levels, and temperature. This provides medics with constant updates on a patient’s condition, allowing them to respond quickly to any concerning changes.
Wound Assessment: Smart bandages could assess the type and severity of a wound, detecting things like bleeding, infection, and tissue damage. This allows field medics to properly triage patients and administer the right treatment.
Targeted Drug Delivery: Some smart bandages can be designed to release medications or other therapeutic agents directly into the wound site. This enables precise, localized treatment without systemic exposure.
Wound Healing Promotion: Active bandages could use electrical stimulation, drug release, or other techniques to actively promote wound healing and tissue regeneration, getting soldiers back into the fight faster.
Remote Communication: Smart bandages could relay data wirelessly to field hospitals or even command centers. This gives doctors far from the front lines the ability to monitor and advise on the treatment of battlefield injuries in real time.
Simplified Treatment: The advanced capabilities of smart bandages could simplify the jobs of military medics, who often have to make quick decisions under intense pressure. Automated monitoring and treatment recommendations could help less-experienced personnel provide high-quality care.
The unique challenges of military medicine make smart bandage technology a valuable tool for the battlefield of the future. By enhancing wound treatment and providing critical data, these advanced dressings could save lives and get injured soldiers back into action more quickly.
This past Thursday at 1000 I arrived at the local CVS in Granbury, TX, and received a COVID and Shingles shot. So far so good. Later on the day, my arm was a little sore but no big deal. We had a late lunch, and in the middle of eating a salmon pattie all of a sudden, I had to vomit and deposited the contents of my stomach into a toilet. Let’s regress here.
In my 25 years in the US Navy, I received countless injections with multiple shots on the same day. I had NEVER had a reaction of any kind taking whatever was thrown at me in stride. You can’t believe the number of shots we were required to have before going In-Country Vietnam. So this is something new for me. I have had previous shingle shots and six COVID shots also.
On Friday morning my Biometrics were whacked. My BP was 89/59, temp was 99.4, and my pulse was 104. Friday night was hell on earth. I had to get up and vomit at least six times with nothing coming up toward the end. We tried some OTC meds to stop vomiting and I just puked it up. Saturday morning things settled down at I slept in until noon. Saturday I was able to keep soup down, and Sunday I was fully back in battery, but stayed in bed until 1000. I was able to blow off storm debris from the porch and driveway and finish putting a border on a front flower bed, even though the humidity was very high and the temp was 90F.
Throughout all of this, I maintained my normal dialysis schedule without any problems or challenges. One lesson to be taken from this is bodies do change in ways you cannot predict. Will I continue to receive shots? Yes, but perhaps with a more critical reading of potential side effects. And life does go on. We just saw our first fawn of the season through our kitchen window. There is a God!
It’s been a couple of weeks since I posted an update on how my latest schema to control my weight by adjusting the strength of my dialysis fluids so here goes an update:
I have 21 recent days of data to share. During this period, my weight has varied from a low of 143.2 to a high of 147.0. When it reaches 145.0 I use a 2.5% 2-liter bag on my early evening static fill. When it equals or exceeds 146.0 I use a 2.5% 6-liter bag along with a 1.5% 6-liter bag on the Cycler. So far, I have used the 2.5% 2-liter treatment five times, and the 2.5% 6-liter bag four times out of 21. Keep in mind that my assigned dry weight is 145.0 so I’m keeping a tight variance on my weight around this value by adjusting the dialysis fluid strength on the fly.
One of the last tasks I do after coming off of dialysis every morning is to weigh myself. Based on this weight, I determine what mixture of bags of fluid I need to keep my weight where I want it, at or below 145.0. Sometimes I can adjust it a pound or two with just the 2.5% 2-liter bags for my static fill; sometimes I have to use the 6-liter 2.5% bags if my weight jumps too much. But it is working for me.
Keep in mind that the rubric I am using does not take into consideration any weight fluctuation from diet or any effect of exercise. But intrinsically, these are factored into my weight. Again, my weight has responded well to this schema.
On May 28, 2024, in the Opinion Section, WSJ ran an article titled “Bureaucrats vs. Kidney Patients” by The Editorial Board. Below is a 250-word condensed version of the article followed by information from Perplexity on just what the tests are that are highlighted in the article. I previously did not know such tests existed.
In August 2023, the National Committee for Quality Assurance (NCQA) removed an at-home kidney test from its list of approved tests, denying patients an easy way to check their risk for kidney disease. The convenient semi-quantitative test uses a urine sample to measure albumin, an early indicator of kidney problems.
NCQA claims the test was “erroneously misclassified” as a lab test, but this seems like bureaucratic confusion. Both the American Diabetes Association and the National Kidney Foundation have endorsed home tests to improve access, especially for rural patients. Eliminating this option will “take us backward rather than forward,” says Dr. George Bakris, who co-authored the guidelines.
Kidney disease often goes undiagnosed until it has caused substantial damage. Over 37 million Americans have chronic kidney disease, and 90% are unaware. Frequent testing is crucial, especially for the 38.4 million Americans with diabetes, a third of whom have kidney disease. Early detection can prevent the need for dialysis, which costs Medicare over $153 billion annually.
While NCQA acknowledges home tests may play a role in the future, they already serve an important purpose. This decision appears to prioritize cost and bureaucratic control over patient needs. Doctors and patients are now pushing back, arguing that easy access to screening is vital for catching kidney issues early and improving outcomes.
Home kidney test kits can provide a semi-quantitative detection of small quantities of albumin in urine, which is an indicator of potential kidney disease. The Accu-Tell Microalbumin Semi-quantitative Rapid Test Strip is designed to detect albumin levels between 20-100 mg/L by showing varying color intensities on the test strip. Similarly, the Healthy.io Minuteful Kidney kit uses a urine dipstick and smartphone app to rapidly detect albumin levels, though it does not provide detailed results. These semi-quantitative tests can help screen for microalbuminuria, an early sign of kidney damage, but positive results should be confirmed with further quantitative testing by a doctor.
A May 24, 2024 article in The New England Journal of Medicine is of interest to all readers of this blog. The lead graphic is captured from the article which is quoted in its entirety below. You can read for yourself that the intake of Ozempic, largely employed as a weight-loss drug, may have salubrious effects way beyond weight.
Abstract
BACKGROUND
Patients with type 2 diabetes and chronic kidney disease are at high risk for kidney failure, cardiovascular events, and death. Whether treatment with semaglutide would mitigate these risks is unknown.
METHODS
We randomly assigned patients with type 2 diabetes and chronic kidney disease (defined by an estimated glomerular filtration rate [eGFR] of 50 to 75 ml per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio [with albumin measured in milligrams and creatinine measured in grams] of >300 and <5000 or an eGFR of 25 to <50 ml per minute per 1.73 m2 and a urinary albumin-to-creatinine ratio of >100 and <5000) to receive subcutaneous semaglutide at a dose of 1.0 mg weekly or placebo. The primary outcome was major kidney disease events, a composite of the onset of kidney failure (dialysis, transplantation, or an eGFR of <15 ml per minute per 1.73 m2), at least a 50% reduction in the eGFR from baseline, or death from kidney-related or cardiovascular causes. Prespecified confirmatory secondary outcomes were tested hierarchically.
RESULTS
Among the 3533 participants who underwent randomization (1767 in the semaglutide group and 1766 in the placebo group), median follow-up was 3.4 years, after early trial cessation was recommended at a prespecified interim analysis. The risk of a primary-outcome event was 24% lower in the semaglutide group than in the placebo group (331 vs. 410 first events; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.88; P=0.0003). Results were similar for a composite of the kidney-specific components of the primary outcome (hazard ratio, 0.79; 95% CI, 0.66 to 0.94) and for death from cardiovascular causes (hazard ratio, 0.71; 95% CI, 0.56 to 0.89). The results for all confirmatory secondary outcomes favored semaglutide: the mean annual eGFR slope was less steep (indicating a slower decrease) by 1.16 ml per minute per 1.73 m2 in the semaglutide group (P<0.001), the risk of major cardiovascular events 18% lower (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P=0.029), and the risk of death from any cause 20% lower (hazard ratio, 0.80; 95% CI, 0.67 to 0.95, P=0.01). Serious adverse events were reported in a lower percentage of participants in the semaglutide group than in the placebo group (49.6% vs. 53.8%).
CONCLUSIONS
Semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes in patients with type 2 diabetes and chronic kidney disease. (Funded by Novo Nordisk; FLOW ClinicalTrials.gov number, NCT03819153.)
This past Friday I authored a post relating the anxiety, fear, uncertainty, and doubt expressed by many in dialysis forums on Facebook. I related while I did not experience such feelings, perhaps it would be lucrative to delve into what research has suggested. Below is what I uncovered.
Research has found that patients new to dialysis often experience significant anxiety, fear, and doubt. Some key findings:
Anxiety disorders are estimated to affect 12-52% of patients with end-stage kidney disease on dialysis.
Starting dialysis is a major life transition that can trigger anxiety as patients adjust to the new diagnosis, treatment regimen, and lifestyle changes.
Common sources of anxiety include fear of the unknown, uncertainty about the future, invasive procedures like needle insertions, alarms on dialysis machines, and dependence on medical staff and equipment.
Patients may feel anxious about being able to follow the strict dietary and fluid restrictions, remember medication schedules, and manage supplies for home dialysis.
The loss of independence, inability to work, financial strain, and disruption to social roles can contribute to feelings of anxiety and doubt.
Anxiety can make it harder for new dialysis patients to learn important self-care skills, follow treatment plans, and cope with the physical and emotional demands of their condition.
In summary, the transition to dialysis brings many stressors and uncertainties that commonly trigger significant anxiety, fear, and doubt in new patients as they adjust to end-stage kidney disease and dialysis treatment.
Back in the day, I was Officer In Charge of a US Navy Unit stationed at Sperry Systems Management in Ronkoma, NY. Our mission was to test and evaluate a new weapon system designed to go aboard the new Oliver Hazard Perry Class FFG-7. One of the enlisted working for me at that time was a first-class petty officer by the name of Robert Shippee. Fire Control Senior Chief Petty Officer (FCCS) Robert Shippee died in the USS Stark (FFG-31) when she was struck by two Iraqi Exocet missiles on 17 May 1987.. My thoughts always go out to him today with wishes of fair winds and following seas. The lead photo is of him.
For those from other countries reading this blog, the below is offered to provide insight into Memorial Day in the USA:
Memorial Day
Federal holiday in the United States
Origins
Originally known as Decoration Day, it marked the remembrance of U.S. military personnel who died in service
First Observance
The first national observance of Memorial Day was on May 30, 1868
Current Date
Observed on the last Monday in May since 1971
Memorial Day is a federal holiday in the United States that honors the men and women who died while serving in the U.S. military. It originated after the Civil War to commemorate the Union soldiers who perished in that conflict.
Origins and History
The first Memorial Day observance was held on May 30, 1868, originally called “Decoration Day,” when General John A. Logan proclaimed that flowers should be placed on the graves of Union soldiers who died in the Civil War. On that first Decoration Day, General James Garfield delivered a speech at Arlington National Cemetery, and 5,000 participants decorated the graves of 20,000 Union and Confederate soldiers buried there. While the exact origins are disputed, the practice of decorating soldiers’ graves with flowers began in various towns across the country in the years following the Civil War. By 1890, Memorial Day was an official state holiday in all the northern states. After World War I, it became a day to honor all American military personnel who died in any war.
Modern Observances
In 1971, Congress declared Memorial Day a federal holiday and changed the observance date to the last Monday in May to create a three-day weekend. On Memorial Day, many Americans visit cemeteries and memorials to honor the fallen soldiers. American flags are placed on graves in national cemeteries, and volunteers often decorate graves with flowers and wreaths. The National Memorial Day Parade is held annually in Washington D.C., and the President or Vice President traditionally lays a wreath at the Tomb of the Unknown Soldier at Arlington National Cemetery. A National Moment of Remembrance is observed at 3 pm local time, when all Americans are encouraged to pause for a moment of silence. While Memorial Day marks the unofficial start of summer for many, it remains an important day of reflection and remembrance for those who made the ultimate sacrifice in service to the nation.
I spent a little bit of time recently browsing through some of the posts on Facebook having to do with peritoneal dialysis. There was a common thread throughout most of the posts. In general, they were made by patients new to dialysis, and more often than not, voiced fear and/or trepidation concerning their entry into the PD world.
While this is understandable to a point, my position is that the care and feeding of new patients is not serving them well. On Facebook, they are reaching out to more seasoned PD patients for consultation and input that obviously they are not receiving as part of their training. In retrospect, I did not have an opportunity to speak to a PD patient or group before or during training. It was not until much later that I was requested to talk to a large group of potential newbies in Fort Worth.
But this begs another issue and involves behavior. Why are patients entering the PD portal so afraid of what they are facing? What is so scary to raise so much fear and doubt among them? Numerous YouTube videos lay out what’s involved in excruciating detail. In training, you are encouraged to ask as many questions as you feel a need to and also progress at a pace you’re comfortable with. Personally, at the onset, I did not experience such feelings nor have I since. Perhaps it’s my military training to take charge and deal with life as it’s dealt to you. I’m certain shrinks have develved into this aspect of PD. I’ll see what I can dig up for a future blog.
